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Orthopaedics · Fractures and dislocations: complications
Sample itemA man develops a tense, swollen calf after tibial nailing. He has severe pain on passive toe extension, but distal pulses and capillary refill are normal. What should be done?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Urgent four-compartment fasciotomy
Compartment syndrome is a clinical diagnosis, with pain on passive stretch an early sign. Pulses are lost late, so waiting for pulselessness costs muscle and nerve; fasciotomy is the treatment.
Option by option
A. Observe until the pulses disappear
Pulselessness is a late sign and waiting leads to irreversible damage.
B. Urgent four-compartment fasciotomy (correct)
Correct. Clinical suspicion with pain on stretch warrants early fasciotomy.
C. Elevate the limb above the heart and review in the morning
Elevation lowers arterial inflow and can worsen perfusion in a compartment syndrome.
D. Doppler study and defer action until it is normal
A normal Doppler does not exclude compartment syndrome and delays decompression.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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